Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients.
Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating less than or equal to 7 than it is in patients with a GCS rating greater than 7 (p = .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.
Lanza
D C
DC
Division of Otolaryngology, Albany Medical Center Hospital, NY 12208.
Koltai
P J
PJ
Parnes
S M
SM
Decker
J W
JW
Wing
P
P
Fortune
J B
JB
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000628:therapy*; D016002:Discriminant Analysis; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014140:Tracheotomy; D015599:Trauma Severity Indices